1114425097 NPI number — L.W.THERAPEUTICS AND CONSULTING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114425097 NPI number — L.W.THERAPEUTICS AND CONSULTING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
L.W.THERAPEUTICS AND CONSULTING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114425097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
149 BALSAM FIR PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAYTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27520-3065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-333-2550
Provider Business Mailing Address Fax Number:
919-439-6415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1540 E FRONT ST STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27527-5492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-333-2550
Provider Business Practice Location Address Fax Number:
919-439-6415
Provider Enumeration Date:
01/25/2018

Additional Information

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
LAKIA
Authorized Official Middle Name:
LATEEFAH
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
919-423-9034

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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